Is there a better indicator for predicting the outcome of trial without catheter?

In this study there are some shortcomings, including retrospective design, short follow-up for a study spanning almost six years and a lack of validated questionnaires. Authors report a negative experience with porcine dermis, both in terms of success and extrusion rate. However, others have reported better outcome[1] which may be due to different follow-up times and outcome measures. Apart from this, biological grafts are also associated with allergic reactions and disease transmission. There is paucity of data regarding prospective randomized trials on the use of these biomaterials prior to their widespread human need which might help in reducing such type of experiences. Unless such data are available surgeons should give serious thought prior to embarking on the use of such biological materials.[2]

In this study there are some shortcomings, including retrospective design, short follow-up for a study spanning almost six years and a lack of validated questionnaires. Authors report a negative experience with porcine dermis, both in terms of success and extrusion rate. However, others have reported better outcome [1] which may be due to different follow-up times and outcome measures. Apart from this, biological grafts are also associated with allergic reactions and disease transmission. There is paucity of data regarding prospective randomized trials on the use of these biomaterials prior to their widespread human need which might help in reducing such type of experiences. Unless such data are available surgeons should give serious thought prior to embarking on the use of such biological materials. [

SummARy
This prospective clinical study was done to assess the impact of intravesical prostatic protrusion (IPP) on the outcome of trial without catheter (TWOC) following acute urinary retention (AUR). Consecutive white men aged 50 years or older with AUR related to benign prostatic hyperplasia (BPH) were recruited for the study. The mean age of these men was 70.1 years. Men with neurological illness, prostatic carcinoma, abnormal renal function, urethral stricture, residual urine > 1500 ml, prostatic or urethral surgery, being treated with anticholinergics and with severe comorbid illness were excluded. All were given 10 mg of Alfusozin daily after catheterization along with treatment of precipitating factors. TWOC was given after two weeks.

CommenTS
Trial without catheter after a short course of α-blockers is often adopted by many urologists for AUR. The predictors for a successful outcome following TWOC are residual urine < 500 ml, gland size < 50 ml, men younger than 65 years, TWOC after prolonged catheterization, lower | October-December 2007 | urinary tract symptoms (LUTS) for less than six months and precipitated AUR. [1] Serum prostate specific antigen (PSA) as a surrogate marker for prostatic volume has also been found to predict the outcome of TWOC. The higher the PSA, the greater is the subsequent risk for unsuccessful TWOC and surgery. [2] In this prospective study on white men, the subjects had a larger mean prostatic volume of 68.3 ml. Men with successful TWOC had smaller prostates and smaller IPP. Whether IPP measurement alone, irrespective of the size of the prostate, can be used to predict the success of TWOC remains unanswered. However, an IPP > 10 mm even in smaller volumes of the prostate (average volume of 39 ml) has been shown to be a predictor of an unsuccessful outcome of TWOC by Tan and Foo in their Asian cohort. [3] IPP was measured by the transabdominal method and no alpha blockers were used in their study. Thus, an IPP < 10 mm has been proved to be a predictor of success after TWOC in both cohorts having people of various races. IPP was also proven to be correlating well with urodynamically proven bladder outflow obstruction. Men with a larger IPP and AUR are less likely to respond to alpha blockade and TWOC. [4] Irrespective of the method of estimation, an IPP > 10 mm in men presenting with AUR due to BPH should set off warning bells that they are unlikely to have successful TWOC and are to be counseled for prostatectomy. IPP may not only predict the success of TWOC outcome, but can also be used in prognostication and treatment of symptomatic BPH. The predicting ability of IPP in the success of TWOC needs to be further established by standardizing its method of estimation and correlating it with other variables like prostatic volume, PSA, residual urine and severity of LUTS in larger multicentric prospective studies.

SummARy
Inflammatory pseudotumors (IPT) are sometimes seen in the follow-up bladder biopsies of patients with transitional cell carcinoma. The relevance of this finding was studied in 809 patients who were on surveillance after the initial definitive treatment for superficial transitional cell carcinoma of the bladder. During this period, there were 16 (2%) patients who had bladder mass but without evidence of malignancy. They had histological evidence of only IPT-spindle cells and inflammatory infiltrate. In all these patients, the primary tumor was a high-grade transitional cell carcinoma.Fifteen of these patients had received adjuant intravesical therapy during the initial treatment. This included intravesical immunotherapy with bacillus Calmette-Guerin (BCG) in 13, intravesical chemotherapy in one and chemoradiation in one. The median follow-up period was 26 months after the diagnosis of IPT. Twelve patients (75%) showed tumor recurrence within a median period of 16 months. All the recurrences were high-grade urothelial carcinoma. Nine (56%) progressed to a higher stage with a median time to progression of seven months from the diagnosis of IPT. Four patients (25%) had evidence of metastases upon diagnosis of recurrence and two more patients developed metastatic disease later. Eventually 12 patients died within a median period of 26 months after the diagnosis of IPT.

CommenTS
It is common to see desmoplastic stromal reactions in